Appeal a WorkSafeBC decision

As an employment lawyer, I have met with dozens of people who have suffered a workplace accident and are now fighting for their compensation benefits. Fortunately, there is an avenue for workers to contest unfair decisions from WorkSafeBC. The process is long and difficult, but in many circumstances workers are able to overturn the decision that denied them their benefits and obtain proper compensation. If you are a worker that has been denied WorkSafeBC benefits, here are five steps to have your appeal heard.

 

1.  Note your deadline for a response

The WorkSafeBC appeal process is always going to begin with a decision letter from a claims manager. This letter will normally cite WorkSafeBC policy and will state why the decision is being made. Normally, workers will have 90 days to request a review of a decision they disagree with.

If you have been denied WorkSafeBC benefits, note this date, circle it on your calendar and do whatever else you need to do to be reminded of it. Don’t let this date pass without taking action! In deciding whether or not to accept your request for review, the first thing that a reviewing officer will look at is whether or not this limitation period has been respected.

 

2.  Start gathering medical information

WorkSafeBC commonly denies claims for a “lack of objective medical evidence”. What this means is that it’s often not enough for a worker to simply tell the claims manager that they are in pain or that they can’t perform the functions of their job. There has to be medical documentation to support this.

With this in mind, start gathering medical information early. Ask your health care providers for support by having them prepare an opinion on your diagnosis, your progress and your prognosis. Ask your family physician to review the opinion of WorkSafeBC’s staff doctor and have them provide comments. If you need to consult a specialist, ask your doctor for a referral and let WorkSafeBC know.

Also don’t be afraid to ask for a copy of your medical charts from your care providers. You are entitled to these documents and they can contain crucial information which may not have been disclosed to WorkSafeBC.

 

3.  Get the help you need

Before you file your request for review, get help. The Workers’ Compensation Act and its supporting policies are very complex, and your appeal may deal with complicated questions of law. Fortunately, support can come from a number of sources, including your union, a workers’ adviser, a friend or family member, or a lawyer knowledgeable in workers’ compensation law. Whatever you decide, familiarize yourself with the process and make sure you are able to identify what legal test needs to be met.

 

4.  Request a Review

The first step in the formal appeal process is to request a review. When a request for a review is received, WorkSafeBC will assign the file to an in-house reviewing officer for reconsideration. This reviewing will provide a second look at the file to make sure that the original decision was appropriate. In conducting the review, the officer can consider written arguments and new evidence. I strongly encourage workers to provide thorough, well thought out arguments supported by evidence when requesting a review.

 

5.  File an Appeal with WCAT

If the worker is unsatisfied with the result of the review, they can then request an appeal to the Workers’ Compensation Appeals Tribunal (WCAT). WCAT hearings can be heard in person, and the worker may have an advocate to present evidence and arguments that support their claim. The employer may also be present at the hearing, although in reality they rarely participate.

The WCAT hearing is a relatively informal process, and often there will only be the worker, their representative and the WCAT chairperson together in a small boardroom. These hearings should be taken seriously, as they are often the best opportunity for the worker to tell their story in full and ask for the compensation they are looking for.

Article written by David M. Brown

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.